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1.
Prog Brain Res ; 184: 221-35, 2010.
Article in English | MEDLINE | ID: mdl-20887878

ABSTRACT

Dopamine replacement for Parkinson's disease (PD) have seen three major iterations of improvements since the introduction of l-3,4-dihydroxyphenylalanine (l-DOPA) pharmacotherapy: dopamine receptor agonists, ex vivo gene transfer for cell transplantation and most recently in vivo gene therapy. In this chapter, we describe the principles behind viral vector-mediated enzyme replacement in PD. We focus on the enzymes involved in the dopamine synthesis and their internal regulation, the early experimental work on gene therapy using different viral vector types and selection of transgenes, and finally discuss the recently completed early phase clinical trials in PD patients.


Subject(s)
Dopamine/physiology , Genetic Therapy , Parkinson Disease/therapy , Animals , Dihydroxyphenylalanine/administration & dosage , Dihydroxyphenylalanine/therapeutic use , Dopamine/biosynthesis , Dopamine Agents/administration & dosage , Dopamine Agents/therapeutic use , Drug Implants , Enzyme Replacement Therapy , Genetic Vectors/genetics , Humans , Parkinson Disease/genetics , Viruses/genetics
2.
Brain ; 133(Pt 2): 496-511, 2010 Feb.
Article in English | MEDLINE | ID: mdl-20129936

ABSTRACT

Viral vector-mediated gene transfer utilizing adeno-associated viral vectors has recently entered clinical testing as a novel tool for delivery of therapeutic agents to the brain. Clinical trials in Parkinson's disease using adeno-associated viral vector-based gene therapy have shown the safety of the approach. Further efforts in this area will show if gene-based approaches can rival the therapeutic efficacy achieved with the best pharmacological therapy or other, already established, surgical interventions. One of the strategies under development for clinical application is continuous 3,4-dihydroxyphenylalanine delivery. This approach has been shown to be efficient in restoring motor function and reducing established dyskinesias in rats with a partial lesion of the nigrostriatal dopamine projection. Here we utilized high purity recombinant adeno-associated viral vectors serotype 5 coding for tyrosine hydroxylase and its co-factor synthesizing enzyme guanosine-5'-triphosphate cyclohydrolase-1, delivered at an optimal ratio of 5 : 1, to show that the enhanced 3,4-dihydroxyphenylalanine production obtained with this optimized delivery system results in robust recovery of function in spontaneous motor tests after complete dopamine denervation. We found that the therapeutic efficacy was substantial and could be maintained for at least 6 months. The tyrosine hydroxylase plus guanosine-5'-triphosphate cyclohydrolase-1 treated animals were resistant to developing dyskinesias upon peripheral l-3,4-dihydroxyphenylalanine drug challenge, which is consistent with the interpretation that continuous dopamine stimulation resulted in a normalization of the post-synaptic response. Interestingly, recovery of forelimb use in the stepping test observed here was maintained even after a second lesion depleting the serotonin input to the forebrain, suggesting that the therapeutic efficacy was not solely dependent on dopamine synthesis and release from striatal serotonergic terminals. Taken together these results show that vector-mediated continuous 3,4-dihydroxyphenylalanine delivery has the potential to provide significant symptomatic relief even in advanced stages of Parkinson's disease.


Subject(s)
Dependovirus , Dyskinesias/prevention & control , Genetic Vectors/administration & dosage , Levodopa/administration & dosage , Parkinson Disease/therapy , Psychomotor Performance , Animals , Chickens , Corpus Striatum/drug effects , Corpus Striatum/physiology , Dependovirus/genetics , Disease Models, Animal , Dyskinesias/genetics , Dyskinesias/physiopathology , Female , Gene Transfer Techniques , Genetic Vectors/genetics , Humans , Levodopa/genetics , Parkinson Disease/genetics , Parkinson Disease/physiopathology , Psychomotor Performance/drug effects , Psychomotor Performance/physiology , Rats , Rats, Sprague-Dawley
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